Stem Cell Transplantation and Cellular Therapy, MDACC, Houston, TX. Intrexon, Germantown, MD. Pediatrics, MDACC. Ziopharm Oncology, Boston, MA

Transcription

1 Shortening the time to manufacture CAR + T cells with Sleeping Beauty system supports T-cell engraftment and anti-tumor effects in patients with refractory CD19 + tumors Partow Kebriaei 1, Helen Huls 2, Susan Neel 1, Simon Olivares 3, Aaron Orozco 3, Shihuang Su 3, Sourindra Maiti 3, Amy Smith 4, Eleanor de Groot 4, Hagop Kantarjian 5, Maro O Hanian 5, Katy Rezvani 1, Elizabeth J. Shpall 1, Richard E. Champlin 1, Laurence J.N. Cooper 4, Harjeet Singh 3 1 Stem Cell Transplantation and Cellular Therapy, MDACC, Houston, TX 2 Intrexon, Germantown, MD 3 Pediatrics, MDACC 4 Ziopharm Oncology, Boston, MA 5 Leukemia, MDACC

2 1 st generation: First-in-human Sleeping Beautymodified T cells Electroporation of DNA plasmids coding for Sleeping Beauty (SB) transposon (CD19-specific CAR) and transposase (SB11) results in: Published data Stable integration of CAR; In vivo persistence of genetically modified T cells; Anti-tumor effects after hematopoietic stem-cell transplantation. New data (2017 ASH #2059) Long-term persistence of infused T cells (currently, detected for up to 4 years in some recipients) Long-term multi-year survival of patients with NHL (OS 100%) and ALL (OS 49%) J Clin Invest Sep 1;126(9):

3 2 nd generation: Improvements to the SB system CAR design Shorten T-cell manufacture on feeder cells Shorten release testing Irradiated feeder cells derived from K-562 genetically modified to co-express CD19 and co-stimulatory molecules

4 Study Design: Clinical Trial # NCT Adult and pediatric patients, 1-80 years Active CD19 + lymphoid malignancies Fludarabine (FLU) & Cytoxan (CTX) lymphodepletion Standard 3+3 design with Dose Levels from >10 5 to 10 9 CD3 + CAR + /kg E.g., PLoS One May 31;8(5):e64138

5 T-cell and Adult Patient Summary Characterization of the infusion product: CAR + T cells were generated by co-culture with feeder cells and cytokines. Total cell manufactured along with percent expression (by flow cytometry) of CD3 and CAR is shown for each patient. Pt # Dose Level Dx Age Lymphodepletion* 6-1 DLBCL 36 Regimen A 2 +1 CLL 68 Regimen B 4 +1 ALL 40 Regimen A 8 +1 ALL 41 Regimen A ALL 16 Regimen B 9 +2 ALL 29 Regimen A ALL 47 Regimen A DLBCL 72 Regimen A *Regimen A: FLU 30 mg/m 2, CTX 500 mg/m 2 x 3 days Regimen B: FLU 25 mg/m 2, CTX 250 mg/m 2 x 3 days

6 Interim Adult Patient Summary Pt # Dose (CD3 + CAR + /kg) Dose Level Dx STIMs* Best Response** Survival Status 6 7.7x DLBCL 2 NR Deceased 2 1x CLL 4 NR Alive, 1 yr 4 1x ALL 3 CR, 3m Alive, 1 yr 8 1x ALL 3 CR, 1m Alive, 3m 16 1x ALL 2 TBD Alive, 1m 9 1x ALL 2 NR Alive, 1m 13 9x ALL 2 CR, 3m*** Alive, 3m 14 1x DLBCL 3 CR, 1m Alive, 1m *The every 7- to 10-day addition of feeder cells is a "stim". Feeder cells derived from K-562 genetically modified to co-express CD19 and co-stimulatory molecules. **Best Response: CR= Complete Response, NR= No Response, PD=Progressive Disease *** MRD +

7 Summary of Related Adverse Events No dose limiting toxicities Dose Level Patient Event Grade Serious Attribution Onset (Days after Infusion) Resolved -1 6 CRS: Fever 1 - PO 5 Y 1 2 Hypotension 2 - PR 0 Y 2 9 Sinus Tachycardia 1 - Def 0 Intermittent 2 9 Fever 1 - Def 0 Y 2 9 Chills 1 - Def 0 Y 2 13 Sinus Tachycardia 1 - Def 1 Y 2 13 CRS: Fever 1 - Def 9 Y 2 14 CRS: Fever, cardiac arrhythmia 2 Yes Def 10 Y Attribution: PO=Possible, PR=Probable, Def=Definitely

8 In vivo persistence of SB-modified T cells Digital droplet polymerase chain reaction (ddpcr) Flow cytometry * *Two outliers omitted Each symbol represents an individual patient and horizontal bar the mean.

9 CAR CD19 C D 1 9 C A R c o p ie s /u g g e n o m ic D N A (P B M C ) CAR CD19 C D 1 9 C A R c o p ie s /ug genom ic D N A (B lood) Detection of T cells and loss of B cells Patient 8 - ALL 4.35% 1-3 Days % 0.006% Post CAR T cell infusion 1 Week 0.074% 0.007% 0.023% 2 Week 0.61% 0.008% 0.084% 3 Months 0.12% 0.004% 0.022% T-cell persistence (ddpcr) B lo o d CD % 0.088% 0.025% 0.007% B a s e lin e 1-3 d a y s 1 w k 2 w k 3 m o n th CD3 D ays post T cell injection Post CAR T cell infusion Patient 14 - DLBCL Baseline 1-3 Days 1 Week 2 Week 0.4% 0.38% 0.015% 0.008% 0.017% % 0.081% 0.009% 1 Month 0.051% 0.004% P B M C s % 0.009% 0.002% 0.008% 0.002% % 0.02% CD % 4.08% % B a s e lin e 1-3 d a y s 1 w k 2 w k 1 m o n th D ays post T cell injection Percent CAR was calculated from CD3 + gated T cells and CD19 was calculated from viable (CD45 + ) lymphocyte gate. CD3

10 Summary and Conclusions Shortened T-cell manufacturing on feeder cells to approximately 2 weeks Modifying testing to rapidly release products Persistence of SB-modified CAR + T cells by ddpcr and flow cytometry Encouraging safety profile and anti-tumor effects Study is ongoing 2 nd -generation SB-modified CD19-specific CAR + T-cell trial serves as platform, providing data supporting 3 rd -generation trial for very-rapid (<2 days) T-cell manufacture under point-of-care (P-O-C)

11 Implementing SB-modified cells Goal: Implement in 2018 a new approach to very rapidly manufacture genetically modified CAR + T cells in under 2 days (termed point-of-care )

12 It takes a village Adult Transplant Faculty Richard Champlin Borje Andersson Elizabeth Shpall Simrit Parmar Katy Rezvani Stefan Ciurea Amanda Olson Roy Jones Yago Nieto Rohtesh Mehta Qaiser Bashir Sairah Ahmed Jeffrey Molldrem Paolo Anderlini Chitra Hosing Uday Popat Issa Khouri Amin Alousi Rima Saliba Gabriela Rondon Muzaffar Qazilbash Gheath Al-Atrash Pediatric Transplant Faculty Kris Mahadeo Sajad Khazal Jessica Foglesong Demetrios Petropoulos PATIENTS GMP Regulatory Group Research Nurses Patient Care Nurses Data Managers